Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-24T22:05:56.625Z Has data issue: false hasContentIssue false
  • English
  • Français

Prospective Surveillance for Surgical Site Infection in St. Petersburg, Russian Federation

Published online by Cambridge University Press:  02 January 2015

Samuel M. Brown ,
Sergey R. Eremin ,
Sergey A. Shlyapnikov ,
Elena A. Petrova ,
Ludmila V. Shirokova ,
Donald Goldmann  and
Edward J. O'Rourke
Samuel M. Brown*
Affiliation:
Davis Center for Russian Studies, Harvard University, Cambridge, Boston, Massachusetts Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University Of Utah Health Sciences Center, Salt Lake City
Sergey R. Eremin
Affiliation:
Department of Epidemiology, Mechnikov Medical Academy, St. Petersburg, Russian Federation
Sergey A. Shlyapnikov
Affiliation:
Department of Surgery, Clinical Railroad Hospital, St. Petersburg, Russian Federation
Elena A. Petrova
Affiliation:
Department of Epidemiology, 26th Municipal Hospital, St. Petersburg, Russian Federation
Ludmila V. Shirokova
Affiliation:
Department of Epidemiology, 4th Municipal Hospital, St. Petersburg, Russian Federation
Donald Goldmann
Affiliation:
Department of Infectious Diseases, Children's Hospital, Boston, Massachusetts
Edward J. O'Rourke
Affiliation:
Department of Infectious Diseases, Harvard Medical School, Boston, Massachusetts
*
Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah Health Sciences Center, Wintrobe 701, 26 North 1900 East, Salt Lake City, Utah 84132 (Samuel.Brown@hsc.utah.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To assess the risk-adjusted incidence and predictors of surgical site infections (SSIs).

Design.

Prospective, multicenter, observational cohort study.

Setting.

Seven surgical departments at 3 urban academic hospitals in St. Petersburg, Russian Federation.

Patients.

All patients had surgery performed between January 15 and May 12, 2000. A total of 1,453 surgical procedures were followed up. Medical records were unavailable for less than 3% of all patients; patients were not excluded for any other reason. The mean patient age was 49.3 years, 61% were female, and 34% had an American Society of Anesthesiologists physical status classification (hereafter, “ASA classification”) of at least 3. Surgery for 45% of the patients was emergent.

Results.

In all, 138 patients (9.5%) developed SSI, for a rate that was approximately 3.5 times the risk-stratified rates in the United States. Male sex (odds ratio [OR], 1.54), ASA classifications of 3 (OR, 3.7) or 4 (OR, 5.0), longer duration of surgery (OR, 2.2), and wound classes of 3 (OR, 5.5) or 4 (OR, 14.3) were associated with increased SSI risk in multivariate analysis. Endoscopic surgery was associated with a lower risk of SSI (OR, 0.23). Antibiotic prophylaxis was used in 0%-33% of operations, and 69% of uninfected patients received antibiotics after the operation.

Conclusions.

The SSI rates are significantly higher than previously reported. Although this finding may be attributable to inadequate antibiotic prophylaxis, local infection control and surgical practices may also be contributors. Use of antibiotic prophylaxis should be encouraged and the effect of local practices further investigated. Active SSI surveillance should be expanded to other parts of the Russian Federation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 3 , March 2007 , pp. 319 - 325
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Martone, WJ, Jarvis, WR, Edwards, JR, Culver, DH, Haley, RW. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. Boston, MA: Little Brown & Company; 1998:461–476.Google Scholar
2.Olson, MM, Lee, JT Jr. Continuous, 10-year wound infection surveillance: results, advantages, and unanswered questions. Arch Surg 1990;125:794–803.Google Scholar
3.Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303–307.CrossRefGoogle ScholarPubMed
4.Cruse, PJ, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.Google Scholar
5.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
6. Consensus paper on the surveillance of surgical wound infections. Society for Hospital Epidemiology of America, Association for Practitioners in Infection Control, Centers for Disease Control, Surgical Infection Society. Infect Control Hosp Epidemiol 1992;13:599–605.Google Scholar
7.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.Google Scholar
8.Belio-Blasco, C, Torres-Fernandez-Gil, MA, Echeverria-Echarri, JL, Gomez-Lopez, LI. Evaluation of two retrospective active surveillance methods for the detection of nosocomial infection in surgical patients. Infect Control Hosp Epidemiol 2000;21:24–27.Google Scholar
9.Sohn, AH, Parvez, FM, Vu, T, et al. Prevalence of surgical-site infections and patterns of antimicrobial use in a large tertiary-care hospital in Ho Chi Minh City, Vietnam. Infect Control Hosp Epidemiol 2002;23:382–387.Google Scholar
10.Sohn, AH, Parvez, FM, Vu, TT. Prevalence of surgical site infections at a large tertiary care hospital, Ho Chi Minh City, Vietnam, 1999 [abstract]. Infect Control Hosp Epidemiol 2000;21:147.Google Scholar
11. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. A report from the National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 1991;12:609–621.Google Scholar
12.Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
13.Horan, TC, Emori, TG. Definitions of key terms used in the NNIS system. Am J Infect Control 1997;25:112–116.Google Scholar
14.Gaynes, RP. Surveillance of surgical-site infections: the world coming together? Infect Control Hosp Epidemiol 2000;21:309–310.CrossRefGoogle ScholarPubMed
15.Ronveaux, O, Mertens, R, Dupont, Y. Surgical wound infection surveillance: results from the Belgian hospital network. Acta Chir Belg 1996;96:3–10.Google Scholar
16.Kjaeldgaard, P, Cordtz, T, Sejberg, D, et al. The DANOP-DATA system: a low-cost personal computer based program for monitoring of wound infections in surgical ward. J Hosp Infect 1989;13:273–279.Google Scholar
17.Gulacsi, L, Kiss, ZT, Goldmann, DA, Huskins, WC. Risk-adjusted infection rates in surgery: a model for outcome measurement in hospitals developing new quality improvement programmes. J Hosp Infect 2000;44:43–52.Google Scholar
18.Simchen, E, Wax, Y, Pevsner, B. The Israeli Study of Surgical Infections (ISSI), II: initial comparisons among hospitals with special focus on hernia operations. Infect Control Hosp Epidemiol 1988;9:241–249.Google Scholar
19.Simchen, E, Wax, Y, Pevsner, B, et al. The Israeli Study of Surgical Infections (ISSI), I: methods for developing a standardized surveillance system for a multicenter study of surgical infections. Infect Control Hosp Epidemiol 1988;9:232–240.Google Scholar
20.Severijnen, AJ, Verbrugh, HA, Mintjes-de Groot, AI, Vandenbroucke-Grauls, CM, van Pelt, W. Sentinel system for nosocomial infections in The Netherlands: a pilot study. Infect Control Hosp Epidemiol 1997;18:818–824.Google Scholar
21.Mertens, R, van den Berg, IM, Veerman-Brenzikofer, ML, Kurz, X, Jans, B, Klazinga, N. International comparison of results of infection surveillance: The Netherlands versus Belgium. Infect Control Hosp Epidemiol 1994;15:574–578.Google Scholar
22.Gulacsi, L, Kiss, ZT, Goldmann, DA, Huskins, WC. Risk-adjusted infection rates in surgery: a model for outcome measurement in hospitals developing new quality improvement programmes. J Hosp Infect 2000;44:43–52.Google Scholar
23.Morikane, K, Nishioka, M, Konishi, T, Ohkubo, T, Kusachi, N, Umeta, S. Initiation of nation-wide nosocomial infection surveillance in Japan [abstract]. Infect Control Hosp Epidemiol 2000;21:156.Google Scholar
24.Nguyen, D, MacLeod, WB, Phung, DC, et al. Incidence and predictors of surgical-site infections in Vietnam. Infect Control Hosp Epidemiol 2001;22:485–492.Google Scholar
25.Geubbels, EL, Mintjes-de Groot, AJ, van den Berg, JM, de Boer, AS. An operating surveillance system of surgical-site infections in The Netherlands: results of the PREZIES national surveillance network. Preventie van Ziekenhuisinfecties door Surveillance. Infect Control Hosp Epidemiol 2000;21:311–318.Google Scholar
26.Lubimova, AV. Reporting and registration of hospital infections: problems and approaches to resolution [in Russian]. In: Proceedings of the First North-West Russia Conference on Infection Control in Healthcare Facilities; March 28, 2000;St. Petersburg, Russian Federation.Google Scholar
27.Averyanov, MG, Sokolovski, VT. Nosocomial infection surveillance in surgical facilities with the use of a monitoring software program [in Russian]. In: Proceedings of the Second Russian Conference on Nosocomial Infections; December 7-9, 1999; St. Petersburg, Russian Federation.Google Scholar
28.Kanshin, NN, Volenko, AV, Fainberg, KA, Germanovich, CS, Pometun, W. Complications of wound healing after appendectomy: medical and economic aspects [in Russian]. Khirurgiia (Mosk) 1991;9:119–123.Google Scholar
29.Dellinger, EP, Gross, PA, Barrett, TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures: Infectious Diseases Society of America. Clin Infect Dis 1994;18:422–427.Google Scholar
30. Scottish Intercollegiate Guidelines Network. Antibiotic prophylaxis in surgery: a national clinical guideline. SIGN 2000;45:1–52. Available at: http://www.sign.ac.uk/pdf/sign45.pdf. Accessed February 15, 2007.Google Scholar
31.Nettleman, MD, Mcintosh, SL, Mcintosh, TJ, Wenger, J, Geerdes, H, Infection control in the Russian Federation: review of a tertiary care hospital. Infect Control Hosp Epidemiol 1994;15:200–202.Google Scholar
32.Brown, SM, Eremin, SR, O'Rourke, EJ. Challenges in quality improvement in peri-operative antibiotic prophylaxis in Russian hospitals [abstract]. Am J Infect Control 2000;28:93.Google Scholar
33.Stratchounski, LS, Dekhnitch, AV, Kozlov, RS. Infection control system in Russia. J Hosp Infect 2001;49:163–166.Google Scholar
34.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
35.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
36.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.CrossRefGoogle ScholarPubMed
37.Brown, SM, Eremin, SR. Development of a Russian epidemiologist's workstation using adapted public domain software tools [abstract]. Am J Infect Control 2000;28:84.Google Scholar
38.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index: National Nosocomial Infections Surveillance System. Am J Med 1991;9: L152S–157S.Google Scholar
39.National Nosocomial Infections Surveillance (NNIS) system report, data summary from lanuary 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
40.Kalmeijer, MD, Nieuwland-Bollen, E, Bogaers-Hofman, D, de Baere, GA. Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol 2000;21:319–323.Google Scholar
41.Garibaldi, RA, Cushing, D, Lerer, T. Risk factors for postoperative infection. Am J Med 1991;9: L158S–163S.Google Scholar
42.National Nosocomial Infections Surveillance (NNIS) system report, data summary from lanuary 1992-April 2000, issued June 2000. Am J Infect Control 2000;28:429–448.Google Scholar
43.Ehrenkranz, NJ, Richter, EI, Phillips, PM, Shultz, JM. An apparent excess of operative site infections: analyses to evaluate false-positive diagnoses. Infect Control Hosp Epidemiol 1995;16:712–716.Google Scholar
44.Taylor, G, McKenzie, M, Kirkland, T, Wiens, R. Effect of surgeon's diagnosis on surgical wound infection rates. Am J Infect Control 1990;18:295–299.CrossRefGoogle ScholarPubMed
45.Sands, K, Vineyard, G, Livingston, J, Christiansen, C, Platt, R. Efficient identification of postdischarge surgical site infections: use of automated pharmacy dispensing information, administrative data, and medical record information. J Infect Dis 1999;179:434–441.Google Scholar
46.Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963–970.Google Scholar
47.Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Toison, JS. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33(suppl 2):S69–S77.Google Scholar